Effects of nonsurgical periodontal therapy in patients with moderately controlled type 2 diabetes mellitus and chronic periodontitis in Nepalese population

Treatment of periodontitis for glycaemic control in people with diabetes mellitus

BACKGROUND

Glycaemic control is a key component in diabetes mellitus (diabetes) management. Periodontitis is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontitis.  Treatment for periodontitis involves subgingival instrumentation, which is the professional removal of plaque, calculus, and debris from below the gumline using hand or ultrasonic instruments. This is known variously as scaling and root planing, mechanical debridement, or non-surgical periodontal treatment. Subgingival instrumentation is sometimes accompanied by local or systemic antimicrobials, and occasionally by surgical intervention to cut away gum tissue when periodontitis is severe. This review is part one of an update of a review published in 2010 and first updated in 2015, and evaluates periodontal treatment versus no intervention or usual care.  OBJECTIVES: To investigate the effects of periodontal treatment on glycaemic control in people with diabetes mellitus and periodontitis.

SEARCH METHODS

An information specialist searched six bibliographic databases up to 7 September 2021 and additional search methods were used to identify published, unpublished, and ongoing studies.  SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 diabetes mellitus and a diagnosis of periodontitis that compared subgingival instrumentation (sometimes with surgical treatment or adjunctive antimicrobial therapy or both) to no active intervention or 'usual care' (oral hygiene instruction, education or support interventions, and/or supragingival scaling (also known as PMPR, professional mechanical plaque removal)). To be included, the RCTs had to have lasted at least 3 months and have measured HbA1c (glycated haemoglobin).

DATA COLLECTION AND ANALYSIS

At least two review authors independently examined the titles and abstracts retrieved by the search, selected the included trials, extracted data from included trials, and assessed included trials for risk of bias. Where necessary and possible, we attempted to contact study authors. Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c), which can be reported as a percentage of total haemoglobin or as millimoles per mole (mmol/mol). Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing, clinical attachment level, gingival index, plaque index, and probing pocket depth), quality of life, cost implications, and diabetic complications.

MAIN RESULTS

We included 35 studies, which randomised 3249 participants to periodontal treatment or control. All studies used a parallel-RCT design and followed up participants for between 3 and 12 months. The studies focused on people with type 2 diabetes, other than one study that included participants with type 1 or type 2 diabetes. Most studies were mixed in terms of whether metabolic control of participants at baseline was good, fair, or poor. Most studies were carried out in secondary care.  We assessed two studies as being at low risk of bias, 14 studies at high risk of bias, and the risk of bias in 19 studies was unclear. We undertook a sensitivity analysis for our primary outcome based on studies at low risk of bias and this supported the main findings. Moderate-certainty evidence from 30 studies (2443 analysed participants) showed an absolute reduction in HbA1c of 0.43% (4.7 mmol/mol) 3 to 4 months after treatment of periodontitis (95% confidence interval (CI) -0.59% to -0.28%; -6.4 mmol/mol to -3.0 mmol/mol). Similarly, after 6 months, we found an absolute reduction in HbA1c of 0.30% (3.3 mmol/mol) (95% CI -0.52% to -0.08%; -5.7 mmol/mol to -0.9 mmol/mol; 12 studies, 1457 participants), and after 12 months, an absolute reduction of 0.50% (5.4 mmol/mol) (95% CI -0.55% to -0.45%; -6.0 mmol/mol to -4.9 mmol/mol; 1 study, 264 participants). Studies that measured adverse effects generally reported that no or only mild harms occurred, and any serious adverse events were similar in intervention and control arms. However, adverse effects of periodontal treatments were not evaluated in most studies.

AUTHORS' CONCLUSIONS

Our 2022 update of this review has doubled the number of included studies and participants, which has led to a change in our conclusions about the primary outcome of glycaemic control and in our level of certainty in this conclusion. We now have moderate-certainty evidence that periodontal treatment using subgingival instrumentation improves glycaemic control in people with both periodontitis and diabetes by a clinically significant amount when compared to no treatment or usual care. Further trials evaluating periodontal treatment versus no treatment/usual care are unlikely to change the overall conclusion reached in this review.

Association between periodontitis and type 2 diabetes mellitus: study in a population attended by the Brazilian Health System

Abstract Introduction Periodontitis control helps to prevent and control diabetes mellitus and understanding of this relationship can lead to changes in health policy. Objective The purpose of this study was to investigate the association between periodontitis, knowledge, and glycemic control. Material and method This is a cross-sectional analytical epidemiological survey with 216 Type 2 diabetic patients, non-smokers, who had current blood screenings with glycated hemoglobin (HbA1c). Result Overall, 93.51% of the patients reported brushing their teeth at least twice a day, 62.5% visited the dentist last year, 81.58% have already undergone treatment for periodontal disease, 43.52% reported having periodontitis and 59.72% had controlled diabetes. No significant (p=0.603) association between HbA1c control and the presence of periodontitis was found. Among the patients with periodontitis, no association between HbA1c control and information on the periodontal disease was found (p=0.996), and know/believe in its relationship with diabetes (p=0.659; p=0.973). Conclusion No relationship between periodontitis and diabetes was found in the sample, as well as in patients with periodontitis, those with knowledge on periodontal disease and knowledge/belief in its relationship with diabetes, which could be justified by the care by a multi-professional health team.

Periodontitis and Risk of Diabetes in the Atherosclerosis Risk In Communities (ARIC) Study: A BMI-Modified Association

PURPOSE

To determine whether periodontal disease is positively associated with incident diabetes across the continuum of body mass levels (BMI) and test the hypothesis that the periodontal risk for incident diabetes is modified by BMI.

METHODS

We included 5569 diabetes-free participants from Visit 4 (1996-1998) of the Atherosclerosis Risk in Communities study and followed them until 2018. Periodontal disease status was classified by periodontal profile class (PPC)-Stages , and incident diabetes was based on participant report of physician diagnosis. We estimated the hazard ratios (HR) for diabetes using a competing risk model for each PPC-Stage. We assessed multiplicative interactions between periodontal disease and BMI (as a continuous variable) on risk of diabetes.

RESULTS

During a median time of 19.4 years of follow-up, 1348 incident diabetes cases and 1529 deaths occurred. Compared to the "Health/Incidental Disease" stage, participants with PPC "Severe Periodontal Disease" or "Severe Tooth Loss" stage and lower BMI had elevated risk for diabetes adjusting for demographic, smoking, education, and biological variables when accounting for death as a competing risk with HRs of 1.76 (95% CI 1.10-2.80) and 2.11 (95% CI 1.46-3.04), respectively. The interaction between PPC-Stages and BMI was significant (P = 0.01). No significant associations of PPC-Stages with incident diabetes were present when BMI was above 31 kg/m2.

CONCLUSION

Periodontal disease was associated with incident diabetes, especially in nonobese participants. Dentists should be aware that periodontal disease is associated with incident diabetes but the association may be modified for patient's at higher BMI levels.

Effect of non-surgical periodontal treatment on gingival crevicular fluid and serum leptin levels in periodontally healthy chronic periodontitis and chronic periodontitis patients with type 2 diabetes mellitus

AIM

The aim of the present study was to evaluate the effect of non-surgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) and serum leptin levels and glycemic status in periodontally healthy patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (T2DM).

METHODS

Ninety patients were divided into three groups: periodontally healthy (group 1), CP (group 2) and CP with T2DM (group 3). The groups were evaluated for clinical parameters of probing pocket depth (PPD), clinical attachment level (CAL), plaque index, gingival index, biochemical parameters of GCF, serum leptin levels, and glycemic status pre- and post-NSPT.

RESULTS

The baseline PPD and CAL for group 2 was 4.98 ± 0.49 mm and 5.35 ± 0.55 mm, respectively; for group 3 it was 5.60 ± 0.38 mm and 6.01 ± 0.38 mm, respectively. There was a considerable reduction in these parameters post-NSPT, with group 2 showing better resolution. Pretreatment serum leptin levels revealed increasing values from group 1 to group 3 and decreasing GCF values from group 3 to group 1, exhibiting an inverse relationship. Group 3 also showed an improvement in glycemic status post-NSPT.

CONCLUSION

NSPT was effective in improving clinical parameters, increasing GCF, reducing serum leptin levels, and also improving glycemic status in patients with CP and CP with T2DM.

The association between Type 1 diabetes mellitus and periodontal diseases

BACKGROUND/PURPOSE

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease affecting oral health. Evidence shows possible association between T1DM and periodontal diseases (PDs). We conducted a nationwide population-based study in Taiwan, with a 14-year follow-up to investigate the risk of PDs in T1DM patients.

METHODS

We used data from the National Health Insurance Research Database in Taiwan. The T1DM cohort was identified with newly diagnosed T1DM from 1998 to 2011. The non-T1DM cohort was frequency matched with the T1DM cohort. Participants comprised 4248 patients in the T1DM cohort and 16992 persons in the non-T1DM cohort.

RESULTS

The T1DM patients showed an increased risk of PDs compared to non-T1DM individuals [adjusted hazard ratio (aHR) = 1.45]. T1DM patients who visited the emergency room more than twice per year had a higher aHR of 13.0 for developing PDs. The aHR for PDs was 13.2 in the T1DM patients who had been hospitalized more than twice per year.

CONCLUSION

T1DM patients are at higher risk of developing PDs than non-T1DM individuals. Our results further showed that the number of T1DM interventions; that is, annual emergency visits and hospitalizations were associated with increased the risk of developing PDs.